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Looking after sexually abused young people in residential settings

Autumn Roesch-Marsh

Sexual abuse in childhood is a traumatic and damaging experience that can have a range of effects for young people as they grow and develop. These can include increased risk of mental health difficulties such as depression and anxiety, psychological symptoms such as low self-esteem and guilt, and problem behaviours such as substance misuse (Avery, Massat & Lundy, 2000; Cotgrove & Kolvin, 1994; Haggerry Sherwood, Garmezy & Rutter, 1996; Mental Health Foundation, 1999; Richardson & Joughin, 2000). A range of research has assessed the impact of sexual abuse and interventions which have been used to help protect against or alleviate resulting symptoms (Finkelhor & Berliner, 1995; Monck et al., 1996; Stevenson, 1999). Central to many of these studies has been the finding that involving the non-abusing parents of sexually abused children in any treatment approach greatly improves outcomes (Deblinger & Heflin 1996; Finkelhor & Berliner, 1995; Karp, Butler & Bergstrom, 1998). While many sexually abused young people remain in the care of their families, a significant number will be placed in substitute care settings. In such settings, opportunities for treatment may be influenced by a greater range of factors and will likely involve a wider range of professionals with less input from family members (Farmer & Pollock, 1998).

Research has suggested that not only are the opportunities for treatment and support of sexually abused young people restricted in residential child care settings, but that residential settings themselves can often be a context for sexually abused young people becoming re-victimised and further traumatised (Brogi & Bagley, 1998; Farmer & Pollock, 1998; Green & Masson, 2002; Lindsay, 1999). In comparing sexually abused and sexually abusing young people to others in substitute care, Farmer and Pollock state that `sexually abused and abusing children are more disadvantaged than others in state care' (Farmer & Pollock, 1998, p. 129).

This claim may seem bold indeed, given the diverse mix of young people in most residential settings (Berridge & Brodie, 1998; Kendrick, Milligan & , Furnivall, 2004). A close examination of policy reports relating to residential childcare shows, however, that there has been an awareness of the plight of sexually abused young people in substitute care for some time. The Skinner Report (1992), the Utting Report (1997) and the Edinburgh Enquiry (Marshall, Jamieson & Finlayson, 1999) all recommend that the safety and needs of sexually abused young people in residential care should be recognised and prioritised by residential services, and that sexually abused young people should not be placed alongside sexually abusing young people.

More recently the Scottish Needs Assessment Programme (SNAP), a Child and Adolescent Mental Health needs assessment, identified a real gap in provision for sexually abused young people who are looked after in residential settings. The report identifies that residential and health services must take a closer look at joint provision for this group (Public Health Institute of Scotland, 2003). Health services have begun to respond to these recommendations by introducing dedicated health projects for looked after children (Kendrick et al., 2004; Residential Care Health Project, 2004; van Beinum, Martin & Bonnett, 2002).

As a residential social worker, I found that the available research seemed to confirm many of the challenges and difficulties my colleagues and I encountered in working with sexually abused young people. These include: risks of revictimisation; difficulty accessing specialist services; and difficulty managing some of the distressed behaviours exhibited by this vulnerable group of young people (Brogi & Bagley, 1998; Fanshawe, 1999; Farmer & Pollock 1998; Lindsay, 1999; Mistral & Evans, 2002).

Avery L, Massat, C.R. & Lundy M. (2000). Posttraumatic stress and mental health functioning of sexually abused children. Child and Adolescent Social Work Journal I7(1), 19-34

Berridge, D. & Brodie, I. (1998). Children's homes revisited. London: Jessica Kingsley.

Brogi, L. & Bagley, C. (1998). Abusing victims: Detention of child abuse victims in secure Accomodation. Child Abuse Review, 7(5)> 315-329.

Cotgrove, A. & Kolvin, I. (I994). The long-term impact of child sexual abuse. In J. Tsiantis (Ed.), Basic child psychiatry (pp. 85-I02). Kastaniotis: Athens.

Deblinger, E. & Heflin, A.H. (1996). Treating sexually abused children and their non-offending parents: A cognitive behavioural approach. London: Sage.

Fanshawe, R. (1999). Working in substitute care settings with sexually abused children: Issues for carers. In A. Harwick & J. Woodhead (Eds.), Loving, hating and survival: A handbook for all who work with troubled children and young people, (pp.205-326). Aldershot: Ashgate

Farmer, E. & Pollock, S., (1998). Sexually abused and abusing children in substitute care. Chichester: John Wiley & Sons.

Finkelhor, D. & Berliner, L. (1995). Research on the treatment of sexually abused children: A review and recommendations. Journal of American Academy of Child and Adolescent Psychiatry, 34(11), 1408-1423.

Green, L. & Masson, H. (2002). Adolescents who sexually abuse and residential accommodation: Issues of risk and vulnerability. British Journal of Social Work, 32(2), 149-168.

Haggerty R.J., Sherwood, L., Garmezy, N. & Rutter, M. (1996). Stress, risk and resilience in children and adolescents. Cambridge: Cambridge University Press.

Karp, C., Butler, T & Bergstrom, S.C. (1998). Treatment strategies for abused adolescents: From victim to survivor. London: Sage.

Kendrick, A., Milligan, I. & Furnival, J. (2004). Care in mind: Improving the mental health of children and young people in state care in Scotland. International Journal of Child & Family Welfare, 7(4), 184-196.

Lindsay, M. (1999). The neglected priority: Sexual abuse in the context of residential child care. Child Abuse Review, 8(6), 405-418.

Marshall, K., Jamieson, C. & Finlayson, A. (1999). Edinburgh's children: The report of the Edinburgh Enquiry into the abuse and protection of children in care. Edinburgh: City of Edinburgh Council.

Mental Health Foundation. (1999). Bright futures: Promoting children and young people's mental health. London: Mental Health Foundation.

Mistral, W & Evans, S. (2002). An innovative project for young people in care who have been sexually abused. British Journal of Social Work, 32(3), 321-333.

Monck, E., Bentovim, A., Goodall, G., Hyde, C., Lewin, R., Sharland, E. & Elton, , A. (1996). Child sexual abuse: A descriptive and treatment study. London: HMSO.

Public Health Institute of Scotland. (2003). Needs assessment report on child and adolescent mental health: final report – 2003. Glasgow: Public Health Institute of Scotland.

Residential Care Health Project (2004). Forgotten children: Addressing the health needs of looked after children and young people. Edinburgh: Astron.

Richardson, J. & Joughin, C. (2000). The mental health needs of looked after children. London: Gaskell.

Skinner, A. (1992). Another kind of home: A review of residential child care. Edinburgh: HMSO.

Stevenson, J. (1999). The treatment of the long-term sequelae of child abuse. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(1), 89-111.

Utting, W (1997). People like us: The report of the review of safeguards for children living away from home. London: The Stationery Office.

van Beinum, M., Martin, A. & Bonnett, C. (2002). Catching children as they fall: Mental health promotion in residential child care in East Dunbartonshire. Scottish journal of Residential Child Care, 1(1), 14-22.

Roesch-Marsh, A. (2005), Good Enough Care? Looking after sexually abused young people in residential settings. Scottish Journal of Residential Child Care, 4(1) pp.45-46

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